Given the close anatomical proximity between the neck and shoulder, it’s no wonder the two are intimately related. In our hectic lifestyles of driving, hunching over computers, talking on the phone, not to mention stress arising from multiple sources, the muscles in the neck, upper back and shoulders seem to tighten up and hurt at the same time. The question is, between the neck and the shoulder, which one is the “chicken” and which is the “egg?”

            The neck gives rise to the nerves that innervate the head (C1-3 nerve roots), the shoulders (C4-5), and the arms (C5-T2). Hence, there are 8 sets of nerves in the neck, 12 sets in the thoracic (middle back region), and 6 sets in the lumbar or low back region and 5 sets in the sacrum, all of which travel to a specific destination allowing us to move our muscles and to feel hot, cold, sharp, dull, vibration and position sense. When these nerves get pinched or irritated, they lose their function and the ability to feel, making it challenging to button a shirt, thread a needle, or pick up small objects.  It can also make it difficult to unscrew jars, squeeze a spray bottle, or lift a milk container from the refrigerator. Hence, the nerves arising from the neck, when pinched, can have a dramatic effect on our ability to carry out our desired activities in which the shoulder, arm and hand use is required.           

            On the other hand, when the shoulder is injured (such as a rotator cuff tear), this can also result in neck problems. There are several ways pain from the neck affects the shoulder and vice versa. When the shoulder is injured, pain “information” is relayed to the brain starting at the nerve endings located in the area of the shoulder injury, transmitting impulses between the shoulder and the neck, and finally from the neck to the sensory cortex of the brain. That information is processed and communication to the motor cortex prompts nerve signals to be sent back to the shoulder through the neck and to the injured area (in this case, the shoulder). A reflex muscle spasm often occurs as a result, serving as kind of an “internal cast” as the muscle spasm tries to protect the injured shoulder. This can become a “vicious cycle” or never-ending “loop” until the reflex is interrupted (perhaps by a chiropractic adjustment). Another means by which both areas become injured has to do with modifications in function. We tend to change the way we go about our daily chores when an injury occurs to the shoulder, such as putting on a coat differently by leaning over to the opposite side. These functional changes can also give rise to neck pain. Because of this reflex cycle, as well as the close anatomic relationship between the neck and shoulder, not to mention the “domino effect” of soft-tissue injuries which seem to change the function at the next joint level, it’s not surprising that both the neck AND the shoulder require simultaneous treatment for optimal treatment benefit. However, the good news is, regardless which one is the “chicken or the egg,” chiropractic treatments of shoulder injuries will almost always include the neck and vice versa.

              For many years, Chiropractic has been at the forefront of treating low back pain (LBP) with both greater patient satisfaction and less lost time at work when compared to other non-surgical treatment approaches. There have been many explanations as to why chiropractic manipulation therapy (CMT) works, but many of these studies include other treatment modalities or methods, and the benefits are therefore not clearly derived only from CMT.  A recent study has tried to clear this up and the results are very interesting! 

            This study included two chiropractors and two a physical therapists (PT) from Canada and the US. What is unique about this study is that they measured clinical or symptomatic improvement by tracking improvement in activity tolerance using a standard questionnaire commonly used by chiropractors and PTs all over the world, as well as changes in the spinal stiffness using a valid/reliable instrument before and after CMT was utilized. The importance of these findings is that only CMT was utilized and hence, other forms of treatment commonly utilized by chiropractors did not cloud the findings. There were 48 patients included in the study and the initial 2 treatments were administered 3-4 days apart, followed by an assessment 3-4 days after the 2nd treatment. Assessments were also performed before and after each treatment. The assessments included use of the questionnaire and a stiffness measurement using the special instrument. Also, “recruitment of the lumbar multifidus muscle” (a muscle in the low back that helps stabilize the trunk or core) was measured by ultrasound. After each treatment, significant improvement was found in the overall pain level and in reduced spinal stiffness (which remained improved 3-4 days after the last/second treatment). 

            The study conclusions revealed less pain, more activity tolerance and less spinal stiffness after the administration of the 2 treatments. The greatest clinical improvement was found in those who had the most dramatic reduction in stiffness after each treatment. They found that the level of muscle recruitment was directly related to the degree of spinal stiffness.  They also found that patients who received thrust manipulation (CMT) had immediate improvements with reduced pain, stiffness and improved muscle recruitment measurements. However, this same effect was NOT obtained when non-thrust mobilization techniques were used. This means many non-thrust manual techniques such as mobilization, massage, and other soft tissue release methods do not create the immediate benefits that were produced by thrust manipulation. 

            With this new information, we are now able to explain with confidence to patients the reasons why they typically feel better after the spinal adjustment. The patient can then appreciate receiving an answer that makes clear sense and has been “proven.” It’s important to realize that the “bonus” of receiving chiropractic care for low back pain includes not only just pain reduction, but more importantly, improvement in tolerating activities such as vacuuming, washing dishes, golfing, walking and of course, working.

You have probably felt that sharp pain traveling down your lower back and into your leg that characterizes sciatica.  You might have seen a chiropractor concerning your discomfort, and chances are they provided some expert advice and treatment to help alleviate some of the pain that you have felt.  Soon, no doubt, the pain subsided, and you were able to continue with your daily life with full vibrancy.  While the skill of your medical professional and time can usually treat the symptom of sciatica, it is important that you, as a patient understand some of the common causes of this condition.  That way, you can recognize it for what it is – your body’s warning system of a potentially serious problem.  In the following paragraphs, a few of the most common causes of sciatica will be discussed.

Sciatica, in essence is caused by problems with your sciatic nerve.  This nerve branches out from your spinal cord in the lumbar region in your back, and continues down the back of each leg.  It controls the muscles in your lower legs, and provides sensation to your thighs, calves, and feet.  It is little wonder why this condition can be so debilitating to the people who cope with it everyday.

Perhaps the most common reason why problems with the sciatic nerve occur is because the nerve root itself is compressed in the lower spine.  This compression is often caused by something called a herniated disk in that general area.

The term herniated disk, probably conjures up images of wheelchairs, aching backs, and people grasping their lower backs, wincing in pain.  In actuality, a herniated disk is nothing more than a tear in the outer covering of the disks in between the vertebrae of the spine.  These disks are essentially pads of cartilage that separate the bones in your spine.  They offer a type of cushioning, provided by a gel-like substance within their core.  These flexible cushions act as shock absorbers for the spine as you move, flex and bend.

However there are occasion, like a herniated disk, when the outer shell will tear.  This allows the gel to leak out, and press on, or compress the nerve in your back.  This can lead to a great deal of pain, numbness, and tingling in your lower back, buttock, leg, and even the foot.  This is perhaps one of the most common, and treatable causes of sciatica.

However, it should be cautioned that a herniated disk isn’t the only cause of sciatica.  One of them is something called a lumbar spinal stenosis.  This condition is simply a narrowing of one (or more) area in your spine.  It most commonly occurs in either the upper region of the back, or in the lower portion.  If it occurs in the lower spine, the sciatic nerve can be adversely affected.

Another example of a cause for sciatica is something called spondylolisthesis.  This tongue teaser is often the result of a degenerative disk disease.  It occurs when one vertebra slips a little forward over another vertebra.  This displacement of the spinal column may pinch the sciatic nerve, leading to the discomfort felt as sciatica.

Another common cause this condition is a spinal tumor.  Tumors can occur within the spinal cord itself, the membranes or meninges that cover the spinal cord, or within the space between the spinal cord and the vertebrae itself.  As it grows, a tumor can compress the cord itself or the nerve roots.

Perhaps one of the most common causes of sciatica in people is trauma, such as car accident.  Anything that causes injury to the lumbar or sacral nerve roots can lead to sciatica.  These can include such things as a severe fall or a blow to the spinal region.

These are just a few of the common causes for sciatica.  It is important that if you are suffering from this condition that you work closely with your Chiropractor to ascertain the underlying cause of the problem.  By doing so, the chance of you making a full and complete recovery from sciatica is nearly assured.

             The term “whiplash” was coined by Dr. Harold Crowe in 1928 during an interview on car collision related neck injuries but he reportedly “…regretted it later.” The term “whiplash” quickly became a household word and relates to a sudden movement of the head producing a neck sprain. It is now accepted that not only forward/backward movements during motor vehicle collisions (MCV) result in neck injury but also side to side and angular movements at the time of impact. In the past, we’ve discussed the number of milliseconds that takes place during the whiplash process after impact (~500 msec.) and the fact that voluntary muscle contraction takes longer (~800 msec.) making it next to impossible to adequately “brace” prior to impact, even when the collision is anticipated. Today, we’re going to look at the symptoms and complaints that are commonly described by whiplash patients. 

            “Early whiplash syndrome” is defined as the condition where immediate or very close to immediate symptoms are noted. One study reported symptoms commonly described after a MVC include the following: neck pain (93%), headache (72%), shoulder pain (49%) and back pain (38%) and, 87% of patients had multiple symptoms. Others reported nausea (48%) and dizziness (38%) as initial symptoms. For some, many of these symptoms resolve within days, weeks or months leaving a smaller percentage with symptoms that last beyond 6 months, which is then referred to as “late whiplash syndrome.” In one study of 52 patients, symptoms improved over a 2 week to 12 month time frame but then remained static or unchanged for the following year. Another study of 117 patients at the 2-year point, reported the following symptoms (the frequency of occurrence is in parentheses): Neck pain (17%), headache (15%), fatigue (13%), shoulder pain (13%), insomnia (12%), anxiety (11%), concentration loss (10%), and forgetfulness (10%). 

            Reasons for the continuation into a late syndrome are supported by two possible causes. 1. It is due to a high level initial symptom, including severe neck pain and headache often with radiating arm pain (radiculopathy). 2. It is caused by the stressful events that are present either at the time of the motor vehicle collision or soon thereafter. These stressors could include work loss, marital stress, financial stress, and/or depression or anxiety issues associated with being injured. It was also reported that the specific type of headache suffered in the late whiplash syndrome in a 47 patient study, 74% had tension-type headache, 15% had migraine and 11% had cervicogenic headache. Some authors have reported that the type of headaches that occur as a result of an MVC are similar to almost identical to those seen after head trauma from other causes including sports injuries such as football, hockey, and boxing. 

            Because “whiplash” results in a mechanical type of injury to the small joints of the neck, muscles and ligaments, the only logical choice for management and treatment is chiropractic.  This is because chiropractic addresses the mechanical injury with a manual, hands-on approach specifically aimed at restoring function in the injured area. Studies are clear that whiplash patients make a faster, less painful recovery, return to work and desired activities faster and are the most satisfied when utilizing chiropractic when compared to covering up the symptoms with medications that have negative side effects that interfere with being able to think and ultimately, reduce productivity.

            Scoliosis is a curvature of the spine that is shaped like a “C” or an “S” when looking at the person from behind. I’m sure you’ve noticed when you’re at a beach, at a swimming pool, or walking in an airport, some people have a high shoulder, walk with a bit of a limp if one leg is short, and may have a shoulder blade that sticks out more than the other. Scoliosis often develops for unknown reasons (hence the term, “idiopathic”) during the adolescent age range between 10 or 11 years old and can progress, not change or less often, improve up to age 16 to 18. During these 4-6 years, the time when the adolescent is growing quickly, the curve often worsens without any intervention but few studies have looked at what types of treatment or combinations of treatment work the best, especially non-surgical methods. 

            A recent study was conducted that looked at the response to non-surgical treatment using conventional medical treatment (MT) vs. conventional MT plus chiropractic, as well as conventional MT and “sham” (fake) chiropractic treatment.  This is a pilot study using a small population of patients in order to determine if a larger scale study would be important to run (which was determined to be the case). 

            The conventional medical treatment approach included two groups – observation (a “wait and watch” approach) in a braced group verses a non-braced group. The chiropractic treatment group received spinal manipulation using “diversified technique” which is widely used where the patient is treated while lying on their stomach, sides, and back and the type of manipulation used was the thrust type where the “cracking” sound occurs (which is caused by the release of gas from the joint capsules and is technically called cavitation). This was applied to the regions determined by the chiropractor as requiring the treatment by using palpation (touch) methods, postural examination, range of motion, and x-ray and all chiropractors involved had 6-hours of training to assure consistent and similar approaches were used. Treatments were administered (determined by a survey of many chiropractors) at 3x/week for a month, 2x/week for a month, 1x/week for a month, and 2x/month for 3 months or as needed for a total of 6 months. The “sham” or fake chiropractic treatment used the same treatment frequency and similar positioning of the patient but purposely did not obtain a joint cavitation or “crack” but still seemed “real” to the patient. 

            The primary outcome used to determine “success” was a reduction of the scoliosis curve measured on x-ray at a 6-month point. Using the standard medical model, those with curves of 20-25 degrees require careful observation, curves 26-40 degrees are potential candidates for bracing, those greater than 40 degrees are potential candidates for surgery and, an increase in curve by more than 5 degrees measured twice a year or every 6-months is considered failure. 

            The results are interesting. Of those receiving only conventional medical treatment, none improved and one failed. The same occurred in the conventional MT plus sham/fake chiropractic. NO ONE failed and one improved in the chiropractic treatment plus MT group making it the only successful non-surgical treatment approach in the study. The preliminary findings from this study are huge! Chiropractic treatment in this group of adolescent children was determined to be THE ONLY non-surgical approach that had the ability to maintain (not allow the curve to progress) or even better, improve the curve!

            Have you ever “banged” your head from falling?  For those playing backyard football, soccer, hockey, or baseball as kids or adults, it’s really quite common. So, how can we tell when the “bang” is dangerous vs. not? And, how does a concussion occur? 

            What is a concussion? A concussion is “traumatic brain injury” (TBI) where the brain is “jarred” and literally bruises as a result of some sort of trauma (a “bang”). 

            What causes a concussion?  Causation is usually from some sort of trauma either by being hit by a moving object (like a ball), from hitting the head during a fall, and even without a direct strike if the head is violently moved back and forth (such as in a “whiplash” injury resulting from a car accident). When there is no direct strike of the head and in the absence of being “knocked out,” the person may not be aware that they have a concussion. 

            What are the symptoms associated with concussion? Immediate symptoms usually include a headache and a reduced level of alertness or consciousness. A concussion temporarily interferes with the way the brain works and as a result (depending on the specific location and degree of the “brain bruise”) it can affect memory (short term the greatest), levels of awareness, judgment, feeling “spacey,” reflexes, speech, balance, coordination and sleep patterns. Other symptoms may include nausea and/or vomiting. Most people describe the experience as an abrupt injury where a bright flash of light occurs in the visual field that blocks the vision temporarily. Many do not actually become unconscious but may say they “blacked out” for a second or two. When unconsciousness does occur, the length of time they are “out” may be a way of determining severity. Symptoms can vary from mild to severe and the following are EMERGENCY symptoms where immediate health care provision is necessary: significant changes in alertness and consciousness, convulsions or seizures, muscle weakness on one or both sides, persistent confusion, persistent unconsciousness (coma), repeated vomiting, unequal pupils, unusual eye movements and walking problems. Neck injury is often associated with a head injury, which is why the injured person is stabilized on a board before being transported. Symptoms during recovery include being withdrawn, easily upset, confused, having a hard time with tasks that require memory and/or concentrating, having mild headaches and sensitivity to noise. 

            What tests are commonly performed on the post-concussive patient and, what is the treatment? A physical exam can include a careful evaluation of the cranial nerves such as pupil size and eye movement, as well as assessment of one’s thinking ability, coordination and reflexes. Special tests may include an EEG (brain wave test), especially when seizures are involved. A head CT scan or head MRI. Treatment may require a hospital stay if severe signs are present. A “wait & watch” approach is often practiced but prompt gentle chiropractic approaches often facilitates healing and should strongly be considered. Refraining from rigorous sports is strongly advised.

As soon as you felt that familiar twinge in your back this morning, you knew that it was going to be a long day. The dull ache wasn’t so bad; really, it was the sudden stab of pain that radiated from your back every time you stepped a little bit out of line. It was tough, but you made it through the day without wincing too badly.

Then you decided enough was enough. It was time to take some action and get some help. So you looked up some of the area doctors and chiropractors in your hometown of North Royalton, Ohio, hoping to find an expert. You were hoping to find some sort of relief.

Thankfully, there are quite a few ads answering to a search for an North Royalton chiropractor. A good one will use spinal manipulation techniques to properly align your skeletal and muscles to help the body heal itself without costly surgery or medication. The manipulation of the spinal column is also used to increase flexibility and mobility of the body, and help to relieve some of the pressure on the nerves that could be the potential source of the back pain.

The first step in any treatment of back pain is a thorough examination and diagnosis. In order to accomplish this, the chiropractor that you choose will perform an extensive physical examination, and may even perform laboratory tests, including X-rays, CT scans, or MRI scans to rule out other, potentially serious causes for the back pain.

Once a good diagnosis is made, there are a number of treatment options available to the chiropractor and patient when it comes to back pain. One of the most common is to manually adjust the spine and some joints with controlled force in the hopes of improving the range and quality of motion of the patient. Other chiropractors will also incorporate nutritional counseling and exercises into their treatment plan.

Depending on the location of the back pain, there are a number of ways that a chiropractor can manipulate the muscle and skeletal system to provide relief to the patient. For example, if the pain is centered on the lower back or lumbar area, a qualified chiropractor may choose to use a technique called Flexion-Distraction. This technique has been used to treat pain in the lower back region that often radiates into the leg region as well. This technique involves the use of a specialized table that can gently stretch the spinal column. This allows the trained chiropractor to isolate the area of discs and vertebrae, as well as performing a flexing of the spine. This allows for some relief of the pressure and compression of the various nerves that can lead to pain in the lower back. For most people, this treatment is relatively painless if done correctly.

If the source of the pain is located in the upper region of the pack, closer to the shoulders, the culprit may in fact be a neck sprain or another injury to the upper area of the back. One of the most common sources of upper back pain is a whiplash injury. In this case, a chiropractor will often use stretching and flexibility exercises and controlled movements to relieve the pressure and realign the spinal column as needed.

No matter the source of your back pain, there is a very good chance that a qualified chiropractor can help alleviate your symptoms. That way, you can wake up in the morning and look forward to a long, and wonderful day.

In my almost 30 years as a chiropractor and nutritional consultant I have treated thousands of patients with many different conditions and I would like to share some observations with you. 

            1. The human body was designed to digest and assimilate food, therefore food-based supplements are the most effective and easily tolerated by the body.

            2. Nutritional support is compatible with any other healing modality, be it natural or allopathic.

            3. If you have a nutritional problem, nothing else is going to fix it.

            4. It may take up to 7 years for a nutritional problem to manifest.  You may change your diet in a way that creates a deficiency of a nutrient, but it may take up to 7 years to deplete your reserves of that nutrient.

            5. It may take years to build up your reserves of that nutrient and restore you to optimal functioning.

            6. Bio-availability is much more important than high potency numbers.

           7. The best time to start nutritional support is 20 years before you think you will need it. 

These are general principles that apply to any form of nutritional therapy; I hope you find them useful. 

Dr. Michael Phillips, Chiropractic Physician

Timber Ridge Neck & Back Pain Clinic

            Last month, we discussed 10 facts about whiplash in attempt to dispel the myths about this topic. Due to the amount of information available, we couldn’t cover them all. So, here are 10 more interesting facts about whiplash: 

1. Much has been published on the association between ongoing whiplash symptoms and litigation. There is now plenty of evidence that ongoing whiplash injury related symptoms occur regardless of the presence or absence of litigation. 
2. The concept of a delay in symptoms means minimal injury is dispelled. In fact, it’s considered “the norm” that symptoms are delayed. 
3. Mild traumatic brain injury (MTBI) or post-concussive syndrome can occur as a result of whiplash trauma. The good news is that, in most cases, recovery occurs within the first 3 months. 
4. In the European Spine Journal, a recent study reported that between 1 and 2 years after a whiplash injury, 22% of patients’ conditions worsened. Condition deterioration at the 2 year mark has also been reported in other studies. 
5. More detailed studies that followed whiplash patients through time, reported that 45% remain symptomatic at 12 weeks (3 months) and 25% at 6 months. Others reported the recovery time in most “minor cases” is 8 weeks (2 months), time to stabilization (not recovery) in the more severe cases was 17 weeks (4 months), and in the most severe category, 20.5 weeks (5 months). Hence, the concept that whiplash, like all other injuries heal in 6-12 weeks is challenged (note, there is little support for this common myth). 
6. Each year, approximately 1.99 million Americans are injured in motor vehicle collisions.  
7. Since 1990, a mean of 40% of a pool of whiplash patients from all vectors of collision (that is, rear, front or side impacts) were still symptomatic at a 2 year follow up. 59% of ONLY rear-end collision patients remained symptomatic at a 2 year follow-up. 
8. Although these estimates vary, approximately 10% of WAD (whiplash associated disorders) injured subjects become disabled to a point of not being able to continue working. 
9. Children who sustain whiplash injuries display sleep disturbances, nightmares, difficulty talking to parents and friends (brain injury), mood changes, poor academic performance and fears of participating in higher impact sports. Moreover, children tend to be overlooked in the evaluation and treatment process since they tend to complain less. 
10. If the size of the 2 impacting vehicles is the same, an 8 MPH impact produces 2 times the force of gravity. When the bullet vehicle is larger than the target vehicle, the difference increases dramatically. 

            Many of us have had sinus related headaches, right?  You know, these are the headaches that hurt over the sinuses (above the eyes or in the cheek bones next to your nose) and, when you blow your nose, it’s not pretty!  Sinus infections often lead to sinus headaches – wouldn’t you say that’s a true statement? 

            A recent November 2011 study begs to differ. Researchers took 58 patients with a diagnosis of “sinus headache” made by their primary care physician and asked them the following questions: 

      1.    Have you had a previous diagnosis of migraine or tension-type headache?

      2.   Is their clinical evidence of a sinus infection during the past 6 months? 

      3.   Is there the presence of “mucopurulent secretions” (that’s the “not so pretty stuff” when we blow our nose)?  

            All 58 patients clearly seemed to have chronic sinusitis with an acute flair up and were given complete thorough examinations by a neurologist and an ears, nose, throat specialist (otolaryngologist) on a monthly basis for 6 months during treatment. The surprising results showed that final diagnosis in these 58 cases were 68%, 27% and 5% of the patients really had migraine, tension-type headache and chronic sinusitis with recurrent acute episodes, respectively. Treatment during the 6 months included antibiotic therapy in 73% of the patients with tension-type headache and 66% with migraine. Sinus endoscopy (taking a look up the sinuses with a scope – ouch!) was performed in 26% of the patients, and therapeutic nasal septoplasty (surgery!) was performed in 16% of the migraine patients and 13% of patients with tension-type headache (a pretty BIG mistake, wouldn’t you say?).  The conclusion was that many patients with self-described or primary care physician diagnosed “sinus headaches” have no sinonasal abnormalities but instead, met the criteria for migraine or tension-type headache. 

            So, what does this mean?  Well, for one thing, too many antibiotics are prescribed for tension-type or migraine headaches and have no place in the treatment process of these two common headache categories.  Side effects of antibiotics include (but are not limited to):  stomach and intestinal irritation, nausea, and if one is allergic to the antibiotic, a potentially life-threatening condition call anaphylactic shock.  Let’s not forget to mention that sinus surgery was performed in 29% of the cases where the sinuses were NOT causing the headaches and we all know the risks of undergoing anesthesia and surgery can include death and infections, among other problems. 

            Chiropractic was reported to be a wise choice in the treatment of headaches by several publications, one of which provided a large review of the literature on the “Effectiveness of manual therapies: the UK evidence report,” released in 2010 (http://chiromt.com/content/18/1/3). In this report, both migraine and cervicogenic-type (headaches that start in the neck) headaches were found to have strong research support for manipulation or, chiropractic adjustments. In this day and age, you can be very confident that choosing chiropractic services for headache treatment is a wise, safe, and very cost-effective approach for a very disabling condition.